Monday, January 01, 2007

Mistake Proofing--unraveling a throrny issue

Mistake Proofing—unraveling a thorny issue

When we think about mistake proofing, we most often think mechanically. The best example is the humble electrical plug. It takes no instructions, can only go in one way, won’t connect to a telephone plug, is safe…in short, truly mistake proofed.

But many processes involve instructions. The (usually) unstated expectation is that the person doing the process can and will read the instruction and follow it. Which often does not happen.

Since I think about such things even while on vacation, I stopped and pondered this sign I saw on a vacant lot while visiting my son in Oregon over Christmas. “No Dumping” seems simple enough. A written instruction which should be followed. And, as my Dad used to say cynically, when seeing such a notice, “Yeah, all the honest people will follow that sign.” I suspect the owner was not really worried about the "honest people."

Stepping back a bit, you can see the owner of this property mistake-proofed her written instruction. This entire vacant lot was completely overgrown with a thorny, gnarly, entangled mess of mutliflora rose vines. Forget the written instruction; this lot screamed silently. "Dumping?? Here?? No way. Go dump your junk elsewhere. "

Why did this intrigue me?? Because it challenged my thinking so substantively. I’m now asking myself how I can “put in some thorns” to assure a written instruction gets followed. I think of my friend Al, a structural engineer, who has to make sure construction crews follow his drawings, to ensure structural integrity. How does he put in some "thorns"? This is not an unusal problem.

What are examples of “thorns” ?
  • a computer entry, requiring a code to proceed
  • a sign-off by a coworker, checking accuracy at the moment
  • a check-out/check-in of specific parts one is instructed to use

There are many more...I'm just brainstorming.

Perhaps this will trigger some creative thinking for you as well. Whatever you do, though, throw your trash somewhere else!! And, if you need to find a cool place to stay along the Oregon coast, I'll put you in touch with my son...thanks, Nathan!


mark graban said...

it's a favorite saying of mine that "warning signs are not error proofing." Telling employees to be careful (instead of really error proofing) isn't necessarily any more effective than a "no dumping" sign. I'll try to post an example of this on my blog soon.

Julien Couvreur said...

I'm curious to see some ideas on this topic. Did your structural engineer friend give you some examples?
I would think that some stuff can be learned from Ikea. For example, they use different spacings between holes so that parts can only fit in the places they are supposed to go.
Actually, it goes back to Murphy's original law: "Every component than can be installed backward, eventually will be."

Anonymous said...

Murphy's Blog law states that any Lean Blog will eventually have a post by Mark Graban on it, doesn't he work?

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